The Impact of Reporting Estimated Glomerular Filtration Rate

Geara, Abdallah S.; Azzi, Nadine; Ghimire, Pratima; Abdallah, Marie; Siddiqui, Ayesha; Bassil, Claude; El‐Sayegh, Suzanne

doi:10.3109/0886022x.2011.574768

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…These guidelines recommend the use of estimated glomerular filtration rate (eGFR) equations to estimate a patient’s renal function. At the present time several articles have been published about, evidencing the impact of these guidelines in clinical practices daily (23–25). When considering that accurate serum creatinine determination is necessary for deriving the above eGRF equations, changes of serum vacuum tubes principally from Tube III to Tube IV (with clinically significant difference) can induce diagnostic errors regarding patient real conditions.…”

Section: Discussionmentioning

confidence: 99%

Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

et al. 2012

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IntroductionThe validation process is essential in accredited clinical laboratories. Aim of this study was to validate five kinds of serum vacuum tubes for routine clinical chemistry laboratory testing.Materials and methods:Blood specimens from 100 volunteers in five diff erent serum vacuum tubes (Tube I: VACUETTE®, Tube II: LABOR IMPORT®, Tube III: S-Monovette®, Tube IV: SST® and Tube V: SST II®) were collected by a single, expert phlebotomist. The routine clinical chemistry tests were analyzed on cobas® 6000 module. The significance of the diff erences between samples was assessed by paired Student’s t-test after checking for normality. The level of statistical significance was set at P < 0.005. Finally, the biases from Tube I, Tube II, Tube III, Tube IV and Tube V were compared with the current desirable quality specifications for bias (B), derived from biological variation.Results and conclusions:Basically, our validation will permit the laboratory or hospital managers to select the brand’s vacuum tubes validated according him/her technical or economical reasons, in order to perform the following laboratory tests: glucose, total cholesterol, high density lipoprotein-cholesterol, triglycerides, total protein, albumin, blood urea nitrogen, uric acid, alkaline phosphatise, aspartate aminotransferase, gamma-glutamyltransferase, lactate dehydrogenase, creatine kinase, total bilirubin, direct bilirubin, calcium, iron, sodium and potassium. On the contrary special attention will be required if the laboratory already performs creatinine, amylase, phosphate and magnesium determinations and the quality laboratory manager intend to change the serum tubes. We suggest that laboratory management should both standardize the procedures and frequently evaluate the quality of in vitro diagnostic devices.

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Section: Discussionmentioning

confidence: 99%

Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

et al. 2012

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“…Indeed, non-compliance with dosing guidelines in hospitalized patients with chronic kidney disease ranges from 19% to 67% [69]. Evidence suggests that reporting estimated glomerular filtration rate (eGFR) may not significantly change prescription habits for nephrotoxic medications, including antibiotics [70,71]. Recently, Joosten et al [60] showed that introducing automatic renal function alerts in the ambulatory care setting, with the involvement of both general practitioners and community pharmacists, was able to reveal that a considerable proportion of the population is at risk for adverse drug events due to impaired renal function.…”

Section: Setting and Intervention Evidencementioning

confidence: 99%

The impact of drug interactions and polypharmacy on antimicrobial therapy in the elderly

Corsonello

Abbatecola

Fusco

et al. 2015

Clinical Microbiology and Infection

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Infectious diseases are more prevalent in older people than in younger adults, and represent a major healthcare issue in older populations. Indeed, infections in the elderly are often associated with higher morbidity and mortality, and may present atypically. Additionally, older patients are generally treated with polypharmacy regimens, which increase the likelihood of drug-drug interactions when the prescription of an antimicrobial agent is needed. A progressive impairment in the functional reserve of multiple organs may affect either pharmacokinetics or pharmacodynamics during aging. Changes in body composition occurring with advancing age, reduced liver mass and perfusion, and reduced renal excretion may affect either pharmacokinetics or pharmacodynamics. These issues need to be taken into account when prescribing antimicrobial agents to older complex patients taking multiple drugs. Interventions aimed at improving the appropriateness and safety of antimicrobial prescriptions have been proposed. Educational interventions targeting physicians may improve antimicrobial prescriptions. Antimicrobial stewardship programmes have been found to reduce the length of hospital stay and improve safety in hospitalized patients, and their use in long-term care facilities is worth testing. Computerized prescription and decision support systems, as well as interventions aimed at improving antimicrobial agents dosage in relation to kidney function, may also help to reduce the burden of interactions and inherent costs.

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Estimating Renal Function to Reduce the Risk of Adverse Drug Reactions

et al. 2012

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The aging process is characterized by relevant changes in pharmacokinetics. Renal function is known to decline with aging. However, as a result of reduced muscle mass, older individuals frequently have a depressed glomerular filtration rate (GFR) despite normal serum creatinine, and such a concealed renal insufficiency may impact significantly on the clearance of hydrosoluble drugs, as well as the risk of adverse drug reactions (ADRs) from hydrosoluble drugs. The assessment of renal function should thus be a mandatory item in the global examination of patient characteristics. Equations for estimating GFR have become very popular in recent years. However, different equations may yield significantly different estimated glomerular filtration rate (eGFR) values, which have important implications in dosing drugs cleared by the kidney. Current knowledge suggests that eGFR based on the Chronic Kidney Disease-Epidemiological Collaboration (CKD-EPI) study equation outperformed eGFR based on the Modification of Diet in Renal Disease (MDRD) study equation and creatinine clearance estimate based on the Cockcroft-Gault formula as a predictor of ADRs from kidney cleared drugs. More recently, the combined creatinine-cystatin C equation was shown to perform better than equations based on either of these markers alone in diagnosing CKD, even in older patients. However, its accuracy in predicting ADRs and usefulness in drug dosing is still to be investigated.

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The Impact of Reporting Estimated Glomerular Filtration Rate

Cited by 3 publications

References 12 publications

Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

The impact of drug interactions and polypharmacy on antimicrobial therapy in the elderly

Estimating Renal Function to Reduce the Risk of Adverse Drug Reactions

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